Last week, a federal district judge in Texas who has not seen a part of the ACA that he thinks is legal, ruled that a significant chunk of the preventive care mandates in the law are either illegal or unconstitutional. The suit was brought by a religiously owned company that does not want to pay for mandated PrEP for AIDS/HIV prevention medication.
Judge O’Connor just held that *key parts* of the ACA’s preventive services requirement are unconstitutional. He upheld the requirements for kids, vaccines, and women (for now) but not those recommended by US Preventive Services Task Force.
— Katie Keith (@Katie_Keith) September 7, 2022
In the short run it is going to get appealed and likely go to the Supreme Court in a year or two.
Insurers are mandated to provide preventive care services because the business case for high value preventive care services is not particularly good from the payer of those services even as they can produce long term societal value. Most preventive care services are not immediately cost saving. There are costs to provide a service, and then, especially for screening services, there are costs of treatment of newly discovered problems. These treatments may produce great value but most of that value is either accruing to the patient or to reduced future medical expenditures. Some vaccines are likely cost saving within a contract year but other than that, it is hard to see cost-savings that an insurer can immediately internalize.
I have a working paper currently under review that looks at the take-up of some of the common preventive care services that are mandated to be cost free. I can’t say much but a common thread in this ongoing work and that of many other researchers is that there are multiple barriers and facilitators to care. Reducing cost to zero is helpful to increase take-up but it is not the only thing that keeps people from getting recommended services.
If this ruling stands or mostly stands without a Congressional update, then insurers will have very strong business cases to impose cost-sharing on almost every preventive service except perhaps flu shots which means screening and prevention will be less common in the future.